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The Truth Behind Double Mastectomies

Hearing the words “You have breast cancer” is scary and life altering. When facing this diagnosis women are not only scared of the battle they have to face fighting the disease, they’re also afraid that, if and when they beat it, it could come back.

It’s this fear that drives many women with breast cancer to undergo a double mastectomy – a surgical procedure to have both breasts removed. However, a new study published in September found that most women don’t need to go to such great lengths to ensure their survival.

The study, published in The Journal of the American Medical Association, found that having both breasts removed has no survival benefit compared with breast-conserving surgery with radiation in women diagnosed with early-stage breast cancer on one side.

“If removing the other breast increased the chance of curing breast cancer on the opposite side, we would recommend it to everyone, but there is no evidence it improves the survival at all, and there is evidence that there is some harm from double mastectomy,” said Dr. Christopher Pezzi, Abington Memorial Hospital’s Director of Surgical Oncology.

The reconstruction procedure after a double mastectomy has a high rate of complications and a patient may have numerous operations over the course of several years as part of the reconstructive process, Dr. Pezzi explained.

“An average patient may have four plastic surgery operations or more as part of the reconstruction process of a double mastectomy, and each of these procedures has a risk of delayed healing and other complications,” he said. That is why a double mastectomy is more risky than a lumpectomy and radiation – it involves a lot more surgery, healing, and a chance for surgical setbacks or complications.

According to the study, women who had a double mastectomy had an 81.2 percent survival rate at 10 years, compared 83.2 percent for those who had breast-conserving surgery.

“We have known for 30 years that a lumpectomy, followed by radiation to the rest of the one breast with the cancer, is exactly as likely to cure breast cancer as a mastectomy,” Dr. Pezzi said, adding that he treats almost 70 percent of patients with Stage 0, 1, and 2 breast cancer with a lumpectomy and radiation.

There are some cases where a patient should have a mastectomy, such as a patient with two cancers in the same breast, a previous history of radiation to the breast, very large tumors, or when the patient has tested positive for genetic mutations known to cause cancer.

However, Dr. Pezzi said most double mastectomies are “patient driven” and not medically required in most cases.

So why are women opting for double mastectomies if they don’t need to? According to Dr. Pezzi, this is due to a number of factors.

“I do feel that there are some patients who choose this option purely because of the understandable fear that comes with being diagnosed with any breast cancer, as well as misinformation or wrong ideas about the benefit of removing both breasts and the true risk of getting a second breast cancer,” he said.

This is where the importance of education comes into play. Breast cancer surgeons should provide their patients with the facts about the benefits and risks of removing both breasts, what it does and doesn’t accomplish, and at what price.

“The first job of a breast cancer doctor is to give the patient information, to educate the patient about what they have, what their true risk is, and what all of the options are for them, so they can make a truly informed decision, and not just a rushed or ‘gut’ decision driven by the fear they are understandably experiencing,” Dr. Pezzi said.

Choosing a breast cancer treatment path is a complicated and difficult decision. That’s why it’s recommended to lean on your breast cancer doctors who have all the right information to help you make the best decision for yourself.

“The best advice is to not rush into this decision, get all the facts and information, and consider a second opinion before proceeding,” he said.